Lecture 34: Child and adolescent health and wellbeing Flashcards
what is self harm? who is at risk?
- intentional self-injury or self-poisoning regardless of the degree of intention to die
- greater risk of suicide than the general population(~30 time higher in the year of following presentation with SH in 10-18 year olds)
- risk is greatest is the period immediately following the episode of self harm and gradually wanes over the subsequent 6-12 months
- suicidal ideation is higher in young people
this is likely becaue people might forget, may not want to remember, may choose not to report as it was a ‘thing of the past’. Increasing prevalence in young people. Likely due to recall bias
what is the epidemiology of SH?
- relatively little known in adolescents in NZ
- many research studies exclude children and adolescents
- undercount estimated to be 50-60%
due to issues with length of hospital stay, ACC claims, presentations for mental illness poorly coded by hospital staff comapred with physical illness, government data reports episodes not people - mutisite sentinel surveillance study is currently underway looking at under 15s and asking pediatricians if they notice self harm
what is the mortality of people aged 28 days - 24 years?
mortality in children and young people aged 28 days to 24 years by age and sex, NZ 2013-2017 combined
2,556 deaths
High in very young babies, increases again during adolescence
what are the main causes of death in children and young people aged 28 days to 24 years?
mortality in children and young people 28 days to 24 years by cause of death, NZ, 2013-17
- medical conditions 37.9%
- unintentional injury 28.7%
- intentional injury 24.8%
- SUDI 8.1%
- missing 0.6%
what are the causes of death in 15-19 year olds?
mortality in 15-19 year olds by cause of sex, NZ, 2013-2017
- suicide 36.2% single bigget cause of death
- unintentional injury - 35.7%
other causes: assault, medical, congenital anomalies, nervous system disease, neoplasms, missing data
how do suicide deaths relate to sex?
from 14 years old, gender discrepancy shows with males having higher suicide rates than females
what are the suicide death patterns in relation to age and ethnicity?
across all age groups, Maori males have the highest suicide rates
how is suicide mortality affected by deprivation?
suicide mortality rates/100,00 in rangatahi aged 10-24 years by NZDep13, compared with non-maori non-pacific children and young people, NZ 2002-2016
Maori have the highest rates in all deprivations, but particularly in increasing deprivation. highest rate in highest deprivation
Pattern not the same for non-maori - rates are lower and more stable across all deprivations.
Poverty doesn’t cause suicide. But there is an association
how many children are in each deprivation index decile? how does it differ by ethncity?
percentage of all children and young people aged 0-24 years in NZ by deprivation index decile and ethnic category 2002-2016
Each decile should have 10% in each decile. non-maori non-pacific have ~10% in each decile, but there are significantly more maori in more deprived deciles.
definite signs of inequality here
how do number of deaths relate to deprivation index?
There are more maori deaths in higher decile (most deprived)
very skewed data
what influences death rates in NZ?
- there are variations between coumtries as to who determines cause of death with regard to suicide
- in new zealand only coroners determine cause of death
- the association with mental illness means in some countries those with mental illnesses are more likely to be classified as suicide, therefore this becomes a ‘self fulfilling prophecy’ with regard to risk factors
- other influences: notes, previous discussion with someone, preferences of family, financial issues
intercountry comparisons: use of inappropriate denominators
how to we conceptualise suicide?
- suicide is an outcome that has multiple aetiologies (e.g. a tragedy or trauma)
suicide is usually a result of multiple other things
what are some scenarios which lead to suicide?
- chronic difficulties with peers at gome and at school
- established psychiatric disorder
- apparently well functioning where death was in response to a life event
this is consistent with work in Aotearoa which suggested very feww adolescents who died had a diagnosed mental illness prior to their death
what does life look like for a suicidal person?
what terms are associated with suicidal people?
- impulsive
- resilience
- self control
- vulnerability
these terms are victim-blaming and imply unpredictability, but suicide is not as unpredictable as we think
what is the heirarchy of effectiveness? how is it relative to suicide prevention?
need a mix of a few of these things for useful prevention
counselling and education required effort on an individual level while addressing socioeconomic factors increases the population impact and decreasing effort from individuals
this ties into the idea of the population paradox
how does the population paradox relate to suicide prevention?
we are very bad at accurately predicting which individuals will be affected by suicide
High risk approach is very logical at an individual level
Cost effective because you aren’t treating people who don’t need it
More motivation to use the treatment
Disadvantages of high risk approach is that you’re only targeting a small part of the population
It doesn’t change the environment that produced those outcomes
Unless you change the environment, more people will end up in the high-risk category
The most cases will still be in the entire population just because the sample is bigger
